multiple pac's can feel them coming on

[joe4185]

I have AVNRT and PAC'S/PVC'S and I am scheduled for an ablation procedure next Thursday to take care of the AVNRT. My question is will the ablation take care of any of the PAC'S/PVC'S that I am experiencing? If I have a cup of coffee or soda I can actually feel them coming on before they happen. I lift weights and am active but the tachycardia only comes on ever so often and the pac's pvc's only bother me when I am resting. If the ablation doesn't help the irregular beats is there a procedure to take care of them? Toporol just doesn't help.

[Forum-M.D.-MJM]

Hi Joe,

The AVNRT ablation will only cure the AVNRT.  There isn't that much that can be done for PVC/PAC's.  It is possible to do ablations for PVC/PACs if they have the exact same appearance (monomorphic) with every beat, but this is not the case for most people with PVCs/PACs.

Antiarrhythmic medications can help suppress them -- like flecainide and propafenone.

My general approach is to:
1. wait to see if you become comfortable with the PAC/PVCs or if they subside (short period)
2. beta blocker to try to decrease the sensation of extra beats
3. consider flecainide or propafenone if very symptomatic
4. ablation only if other modalities didn't work, the events are of a single morphology, and you cannot tolerate symptoms.

I hope this helps.   Thanks for posting.

[sb786]

I had exactly the same question as you but i am never able to post a question to the doc! My ablation is in June.
Good luck with your ablation and let us know how it goes!

[KarenSA]

Hi Joe.  Sounds like I have a similar problem to you with avnrt plus ectopics, thought I would share my experience.  I did have an ablation for atypical avnrt plus atrial tach in October 2005.  It was successful but it took a few months for my heart to settle down afterwards.  I did get tachycardia during this time but after about 6 months, that stopped completely and I have been free since.  Life has been bliss with a quiet, slow heart rate, fantastic and a whole new experience! I was terrified before the procedure but it was much easier than I expected.  I was also well briefed by my Doc so I had no surprises afterwards.  I do get frequent PVC's and have had a holter to investigate them.  I have one site in the right ventricle and one site in the left ventricle.  I want to get them ablated as I am very symptomatic.  Between 200-800/day, depending on how I manage my diet and my stress levels and sometimes for no reason at all.  Sometimes I am lucky and can go for a day or two with none.  I am currently trying to find out more about PVC ablation and its success rates with current ectopic ablation technology.  My EP quoted me a 50/50 chance of pvc ablation success and suggested that I wait until technology advances, unless I become desperate before then.  He is a great doc and I have lots of faith in him as he was successful with my first ablation and has always been very transparent and honest with me.  I will definitely be having a PVC ablation, it is just a matter of time.   Having got some of my life back with the avnrt and atrial tach ablation, I want it all back!  I am tired of tip-toeing around my heart and how it might or might not react to normal living.  I did try meds but it got worse so now I don't take anything.
Good luck with your ablation!  

[joe4185]

So the ablation did nothing for the pac's pvc's? It seems like when I have an episode of tachycardia it is generated by a pvc or pac. Though it is rare when I have an episode of tachycardia the last episode sent me to the emergency room. The crappy part was it ended before the nurse could put the pressure cuff on. Some people say the pac's, pvc's get worse after an avnrt ablation, is this the case with you?

[sb786]

My EP told me that the PVCs and PACs tend to increase after the ablation for a few months but then they do usually reduce in number.
Why is it people who have svt tend to get alot of pvcs/pacs too? My doc said in some people when the svt goes the PVCs may too but it may take longer for them to go.

Karen: How frequent and severe were your svt attacks before the ablation?
Have you had the PVCs for a long time? Did any meds calm the pvcs for you? I too get alot of pvcs, usually between 10-200 a day even though i take beta blockers and i feel every single one. I asked my EP for  meds or ablation to cure the PVCs but he wasn't happy and told me unless i was fainting or very symptomatic he didn't want me to have the pvc ablation.

[joe4185]

I was taking toporol 50mg up until the 7th of this month. The doctor told me to stop the medication 7 days prior to my ablation so he could provoke the tachycardia. I can say that compared to now, the medicine did help with the pvc's, although the pac's continued. I feel the pac's mostly when I am awaken from sleep, the pvc's come mostly when I have been awake or with activity. The SVT only affects me once a month or so, seem to be spurred by a pvc or pac. I have had pac's and pvc's nonstop for about 6 mos now. I have had svt for as long as I can remember, coming only once every couple of months, To tell you the truth the pac's and pvc's bother me more than the SVT. ???????

[anacyde]

Great question!  I have SVT as well as PACs and PVCs and I have always wondered if an ablation for SVT also stops PACs, or if they're different altogether.  For me, PACs in high frequency are what triggers my SVT.

[tickertock]

All interesting questions. I have suffered with tachycardia & PVCs all my life , now 42 Male, basically occasionally a PVC will initiate/trigger a tachycardia for me. In the older days I had docs call it PAT, never had to have an injection to stop it. In the later years it was called Sinus tachycardia with PVCs. Luckily I never had an attack while on atenolol, though I still get an occasional PVC, so rare now they are probably less than 30 a month, though occasionally I'll have 10 in a day, since on atenolol they have never really triggered a tachycardia, maybe once or twice and that was few hours in between doses and the rate was probably 110-130.

I have asked EPs/cardios about ablation several times because before I used to have PVCs in the 1000s daily for months and also regarding my tachy, always got the same reply I don't qualify for a tachycardia or PVC ablation , especially the PVC ablation I have been cautioned very strongly against it. I guess because because the atenolol completely controlls my tachycardia.

I have been given the impression by these docs that ablation is mainly reserved for significant arrhythmias such as WPW with rapid Ventricular response/ unifocal Vtach, clear cut AVNRT with significant symptoms, also many persons have these arrhythmias with not no DOCUMENTED PALPITATIONs and that in most cases ablation is reserved for symptomatic relief of arrhythmias that are none life threatening or for arrhythmias without symptoms that pose a threat whether symtoms are present or not.

[joe4185]

I totally agree

[sb786]

I feel exactly the same, the PVCs are more on my mind than the actual svt.
I think the thing that freaks me out the most is that like you i have had svt for most my life but the pvcs only just started 5 months ago. Its the fact that they have suddenly just appeared that concerns me!!

[sb786]

Is SVT always triggered by an ectopic beat?
If thats the case then i must have had the ectopics for as long as i have had the svt....

[CollegeGirl143]

just wanted to ad

i had an ablation for AVNRT, i used you have frequent palps as well.. After the ablation i was in bigeminy
for a few weeks, but after that, my FELT palps reduced greatly.. I went from around 50 a day, to maybe one or two felt palps a month.. i still get them, when hooked up to a monitor i can see the pvc's, but dont feel um :) so i dont give a care if they are there anymore :-P

[KarenSA]

Hi Joe
No, ectopics remained. Ablation for tachyarrythmia targets the tachycardia only.  I have had PVC's for many years now.  Since the ablation they have become far more frequent although less intense.  I attribute this to two things: 1. The slowing of my heart rate as a result of the successful atrial tach ablation.  After that was ablated, my heart rate of around 100-140 beats frequently during the day before the procedure suddenly dropped to 60 at rest. Before the procedure it would very seldom go below 80 and I could always feel my heart beating - pounding sometimes, even at rest.  Now I don't feel it at all.  PVC's have ample time now between normal beats to have a look in.  At faster rates, I got much fewer ectopics.  How true it is that slower rates allow for more ectopics, I don't know.
2.  Before the procedure the presence of atrial tach, I think, meant for a much more forceful and intolerable follow up beat, as I believe that the atrial tach was triggered by many of the ectopics I had.  With it now gone, my follow up beats are so much softer and more liveable. So I could say that my ectopics have improved somewhat too in my case.
Even though my ectopics are much more frequent since the procedure, I am still delighted that I had it done as I no longer have to live in fear of a sudden sustained attack of avnrt or atrial tach.  With that out of the way I can turn my attention to managing the PVC's and perhaps having them successfully ablated in the future when it is a more commonly done ablation with high success rates.  

[KarenSA]

Hi.  My avnrt had deteriorated in the 6 months prior to the procedure to about 3 or 4 attacks / month.  Usually of short duration - 30 seconds at a time more or less.  I lived in fear of the 'long run' hitting me at any time. The Atrial Tach was virtually a daily event for years.  As soon as I got busy and started rushing around it would present itself.  If I got nervous, it would present itself. It could run for ages as well.  I have lived with it since my early twenties and did not regard it as abnormal because it had become so much a part of my life, until my Doctor commented on my holter results that the sustained rate of 140 was not normal. They could not diagnose it on the holter though and only in the EP lab could it be diagnosed accurately and ablated successfully.  PVC's I have had for about 13 years now.  I tried a Beta Blocker but they got so much worse and I had a really bad run of what I think was ectopic tachycardia one night that I am terrified of taking meds again.  I have noticed a few more people having PVC ablations in the last year compared to what I read about 3 or 4 years ago.  My EP is still hesitant however but if I am desparate he says he will attempt it for me and as I know he would not ablate unless he was 100% certain he had the right spot, I would trust him.  His unit does around 50 ablations / month so he is highly experienced.  His feeling is that technology for ectopic ablations is going to advance and I should wait until then.    

[suesouth]

Hi Karen,
You mentioned your diet and stress level affected your condition.  Can you clarify the diet part.  I have had one atrial tachycardia ablated, but there many other that my EP couldn't ablate because they couldn't be sustained long enough.  My tachycardia is better, but the PVC's (bigeminy/trigeminy/ectopics) are making me crazy.  Any advise would be appreciated.

[aussie mum]

Hi every one i was just wondering what some of these abbreviations mean ?? Are pac/pvc just different types of palpitations ??

1) AVNRT

2) PAC

3) PVC

4) SVT

5) TACHYCARDIA

I think most of the time i seem to get palpitation when at rest as my heart rate is slower. I've given up trying to sleep on my left side (LOL)  Guess i'm not alone when it comes to that !!

[gi in az]

I had PVC ablations done.  The third time I had it done it finally worked for me. I was having 30,000+ a day and my heart rate was 34-40 beat a minute. The 3rd ablation done they had to do epicardial. One of the catheters was inserted thru the chest.  Needless to say, I was having symptons. Also was working full time.  I am now down to about 1000pvcs a day and feeling much better.  PVC ablations they do not like to do unless having medical problems and not just feeling them or feeling anxious about them.  

[sb786]

If you don't mind me asking did your pvcs progress slowly over a period of time? I have anywhere between 5-200 pvcs a day for the past 5 months. I worry that over time i will too start to get more. I am 27 at the moment and fear that by the the time i am 40 i will have thousands a day.

[gi in az]

Years ago I had them and controlled them with medications.  They never went away entirely but I was able to live with them. Then about 4 years ago the medication I was on quit working for me.  I was in Bigemy most of the time, and it cause my heart rate to be in the 30's.  This was continuous 24hr a day.  We tried many different meds, and none of them would help or I coud not tolerate them.
That is when Ablation was suggested to me.It took almost 3 years to get them under control.  After the 3rd attempt, they were able to reach the foci where the one that was causing the most problems was.  Like I said before,  I still have alot of them but with my heart rate now in the 70-90,  I can tolerate them.  The problem  before was that my heart rate was so slow, it was causing a lot of symptoms. I hope this answers your question.

[sb786]

Thanks for the reply. I'm glad you had a successful ablation finally and are having some relief from the pvcs. I feel every single one and i don't know how someone who gets thousands a day copes. Did something specific trigger your pvcs or did they just suddenly appear like mine?

[KarenSA]

Hi.  I have had to cut out all caffeine, including the small amounts found in normal tea.  I can only drink caffeine free tea(like Rooibos) but cannot drink decaff coffee as it still contains caffeine.  I cut chocolate out of my diet only about a year ago because I became desperate.  Chocolate contains caffeine plus theobromine, both stimulants and when present together apparently they potentiate each other.  I have been much better since I cut down drastically on chocolate (I ate a lot!).  I don't touch alcohol at all, it also really upset my heart.  I have also cut my sugar intake completely.  Now and then I will have something sweet or a chocolate but I have to eat just a little.  White chocolate contains next to no caffeine so I can tolerate it much better. I watch my stress levels and have started reading regularly to destress. I also listen to relaxing music just before bed.  My ectopics sometimes trouble a lot at night.  
Hope this helps!  I too hate these things and am putting all my hopes on being able to get them ablated in years to come.  Regards Karen